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Insulin Administration

American Nurses Association v. Torlakson (2013) 57 Cal.4th 570

On August 12, 2013, the California Supreme Court issued a highly anticipated decision regarding administration of insulin to students in California schools.  In American Nurses Association v. Torlakson, the state’s highest court held that trained, unlicensed 1 school personnel may administer insulin to students.  The Court’s holding is summarized in the following language from the opinion:

…we conclude California law does permit trained, unlicensed school personnel to administer prescription medications, including insulin, in accordance with written statements of individual students’ treating physicians, with parental consent… Because schools may administer prescription medications only in accordance with physicians’ written statements… state law in effect delegates to each student’s physician the decision whether insulin may safely and appropriately be administered by unlicensed school personnel or instead whether a particular student’s medical needs can be met only by a licensed health care provider.  State law, however, presents no categorical obstacle to the use of unlicensed personnel for this purpose. [Internal citations omitted.]

Districts may now utilize either a nurse or unlicensed personnel to administer insulin during the school day so long as they meet the following conditions:

    •  The school or district must annually obtain a written statement from the child’s medical provider (physician, surgeon, or physician’s assistant) detailing: (1) the name of the medication; (2) the method of administration; (3) the amount of medication; and (4) the time schedules by which the medication is to be administered.  (Ed. Code, § 49423(a); 5 CCR § 600(a).)
    •  The school or district must annually obtain a written statement from the parent, foster parent, or guardian of the student indicating the desire that the school district assist the pupil in the matters set forth in the statement of the medical provider.  (Ed. Code, § 49423(b); 5 CCR § 600(b).)
    •  The unlicensed personnel must be trained in the administration of insulin.  (Ed. Code, § 49423(a)(2).)
    •  The unlicensed personnel must be under the supervision of a credentialed school nurse, public health nurse, or licensed physician/surgeon. (Ed. Code, § 49423(a)(2).)
    •  The unlicensed personnel must consent to administer insulin (i.e. the service must be voluntary).  (5 CCR § 601(e)(1).)

This update is informational and not intended as a substitute for legal advice.  If you would like more specific information on this topic, please contact us.


1           Unlicensed personnel are those who do not hold a medical license (MD, RN, LVN, etc.) which permits the administration of medication.


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